Neurology & Pain Management Coding Alert

Don’t forget to check the documentation of status epilepticus.

ICD-10 will bring big changes to your epilepsy reporting -- more specific codes for partial seizures and less specific codes for infantile spasms. Keep your focus on capturing the presence of status epilepticus to accurately report diagnoses for simple and complex partial seizures and infantile spasms.

When reporting partial seizures, adopt the following sequence to get to the most accurate code: determine simple vs complex; confirm intractable vs not intractable; and check documentation for presence of status epilepticus.

Check for Status Epilepticus in Complex Partial Seizures

When reporting complex partial seizures (whether intractable or not), check for documentation for status epilepticus.

In ICD-9, you report code 345.40 (Localization-related [focal] [partial)] epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy) for complex partial seizures that are not intractable. In ICD-10, you will choose from codes G40.201 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus) or G40.209 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus), depending upon whether status epilepticus was present.

Similarly, for intractable complex partial seizures, you will need to check for documentation of status epilepticus. The ICD-9 code 345.41 (Localization-related [focal] [partial] epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy) maps to codes G40.211 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus) and G40.219 (Localization-related [focal] ([partial] symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus) in ICD-10.

Also Look for Cause in Simple Partial Seizures

When reporting simple partial seizures (both intractable and not intractable), verify that your clinician documents whether status epilepticus was present.

ICD-9 code 345.50 (Localization-related [focal] [partial] epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy) implies epileptic syndromes that are not intractable.

As in complex partial seizures, 345.50 for simple partial seizures maps to codes G40.101 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, with status epilepticus) and G40.109 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus), depending upon whether status epilepticus is documented or not.

Similarly, the ICD-9 code for intractable simple partial seizures, 345.51 (Localization-related [focal] [partial] epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy), maps to codes G40.111 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus) and G40.119 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus).

Next step: Once ICD-10 goes into effect, you’ll need to ascertain whether the seizures were idiopathic or had a definitive cause supporting the occurrence.

When your neurologist indicates the epilepsy with localized onset is idiopathic, you have independent codes for localized seizures that are intractable and those that are not intractable. You again need to determine if there is any documentation supporting status epilepticus. Code 345.50 also maps to two more codes in ICD-10, G40.001 (Localization-related [focal] [partial] idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, with status epilepticus) and G40.009 (Localization-related [focal] [partial] idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus).

Similarly, the ICD-9 code 345.51 also maps to two additional ICD-10 codes for idiopathic seizures of localized onset, G40.011 (Localization-related [focal] [partial] idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus) and G40.019 (Localization-related [focal] [partial] idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus).

Don’t Be Specific for Infantile Spasms

Infantile spasms, also called West Syndrome, are typical seizures that manifest within the first year of life and may show a spontaneous resolution by age five. There may be developmental regression and chaotic brain waves seen in electroencephalography. "The infantile spasms include the following three types of seizure activity: lightening attacks, nodding attacks and salaam or jackknife attacks. The three types of attacks usually appear simultaneously, however, they can occur independently of each other," says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, CO.

Currently: You report infantile spasms using ICD-9 codes 345.60 (Infantile spasms without intractable epilepsy) and 345.61 (Infantile spasms with intractable epilepsy) depending upon whether or not intractable epilepsy is present.

Future: You’ll not find a specific code for infantile spasms or West Syndrome in ICD-10 Tabular List, however the Alphabetic Index directs coders to the listing for specified generalized epilepsy NEC. Subsequently, ICD-9 code 345.60 maps to G40.401 (Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus) and G40.409 (Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus). Choose the correct ICD-10 code based on whether the seizures are documented to be accompanied by status epilepticus.

In ICD-10 for intractable infantile spasms, you will choose either G40.411 (Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus) or G40.419 (Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus).

Editor’s note: Read more on ICD-10 codes for other forms of epilepsy and some useful definitions in the next issue of Neurology Coding Alert, Vol.15 N2.